Evidence map›Paper›PMID 24824199›Full record

ArticlePloS one2014

Poor reliability between Cochrane reviewers and blinded external reviewers when applying the Cochrane risk of bias tool in physical therapy trials.

Susan Armijo-Olivo, Maria Ospina, Bruno R da Costa, Matthias Egger, Humam Saltaji, Jorge Fuentes, Christine Ha, Greta G Cummings

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 13 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
42citing papers in PubMed, 13 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

42 citing papers in PubMed, 13 syntheses or guidelines pooled it.

  1. The Effectiveness of Mulligan's Techniques in Non-Specific Neck Pain: A Systematic Review and Meta-Analysis.Physiotherapy research international : the journal for researchers and clinicians in physical therapy · 2025
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  6. Needle size for vaccination procedures in children and adolescents.The Cochrane database of systematic reviews · 2018
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  7. Exercise for rheumatoid arthritis of the hand.The Cochrane database of systematic reviews · 2018
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Susan Armijo-OlivoCLEAR (Connecting Leadership and Research) Outcomes Research Program, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.
Maria OspinaEmergency Medicine Strategic Clinical Network, Alberta Health Services, Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canadá
Bruno R da CostaDepartment of Physical Therapy, Florida International University, Miami, Florida, United States of America.
Matthias EggerInstitute of Social & Preventive Medicine, University of Bern, Bern, Switzerland.
Humam SaltajiOrthodontic Graduate Program, School of Dentistry, University of Alberta, Edmonton, Alberta, Canadá
Jorge FuentesFaculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada; Catholic University of Maule, Department of Physical Therapy, Talca, Maule, Chile.
Christine HaRehabilitation Research Center, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
Greta G CummingsCLEAR (Connecting Leadership and Research) Outcomes Research Program, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.

Funding

Canadian Institutes of Health Research
6 · The paper itself

Abstract

objectivesTo test the inter-rater reliability of the RoB tool applied to Physical Therapy (PT) trials by comparing ratings from Cochrane review authors with those of blinded external reviewers.

methodsRandomized controlled trials (RCTs) in PT were identified by searching the Cochrane Database of Systematic Reviews for meta-analysis of PT interventions. RoB assessments were conducted independently by 2 reviewers blinded to the RoB ratings reported in the Cochrane reviews. Data on RoB assessments from Cochrane reviews and other characteristics of reviews and trials were extracted. Consensus assessments between the two reviewers were then compared with the RoB ratings from the Cochrane reviews. Agreement between Cochrane and blinded external reviewers was assessed using weighted kappa (κ).

resultsIn total, 109 trials included in 17 Cochrane reviews were assessed. Inter-rater reliability on the overall RoB assessment between Cochrane review authors and blinded external reviewers was poor (κ  =  0.02, 95%CI: -0.06, 0.06]). Inter-rater reliability on individual domains of the RoB tool was poor (median κ  = 0.19), ranging from κ  =  -0.04 ("Other bias") to κ  =  0.62 ("Sequence generation"). There was also no agreement (κ  =  -0.29, 95%CI: -0.81, 0.35]) in the overall RoB assessment at the meta-analysis level.

conclusionsRisk of bias assessments of RCTs using the RoB tool are not consistent across different research groups. Poor agreement was not only demonstrated at the trial level but also at the meta-analysis level. Results have implications for decision making since different recommendations can be reached depending on the group analyzing the evidence. Improved guidelines to consistently apply the RoB tool and revisions to the tool for different health areas are needed.

Indexed as

Physical Therapy ModalitiesRandomized Controlled Trials as TopicResearch DesignReview Literature as TopicBiasHumansReproducibility of Results

Identifiers

PMID24824199
PMCPMC4019638

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.